パーキンソン病の病理像を呈した老年期痴呆の1剖検例

An Autopsy Case of Senile Dementia with Pathological Features of Parkinson's Disease

　要旨　生前の臨床症状で明らかなパーキンソン症状を認めず，痴呆症状を主症状とし全経過4年で死亡したが，死後の病理学的検索において黒質や青斑核にLewy小体を伴う神経細胞脱落を認め，パーキンソン病に矛盾しない所見を認めた1剖検例を報告した。老人斑は広範に分布していたが，神経原線維変化はわずかに辺縁系に限局するのみでアルツハイマー型痴呆にあてはまらなかった。これまでにも臨床的にパーキンソン病の症状を認めずに神経病理学的にパーキンソン病であった報告はいくつかなされており，考察ではパーキンソン病とその類縁疾患の臨床-病理相関を検討した。

　We report an autopsy case of Parkinson's disease mimicking senile dementia of the Alzheimer type. A Japanese man developed memory disturbance and visual hallucination at age 70. Although he died from pneumonia at age of 74, he had no neurological signs throughout the clinical course. The weight of his brain was 1,420g. Macroscopic examination of the brain revealed prominent depigmentation of the substantia nigra and locus ceruleus. Histological examination disclosed neuronal loss with astrocytosis and the appearance of the Lewy bodies in the nucleus basalis of Meynert, substantia nigra, locus ceruleus, and dorsal vagal nucleus. There were widespread senile plaques in the brain, including the precentral gyrus, which was compatible with Braak stage C. A small number of neurofibrillary changes were present in the limbic areas, consistent with Braak stage III. This case is consistent with brain stem dominance with the pathological diagnosis of the Consortium on Dementia with Lewy Bodies International Workshop. That is, it is compatible with Parkinson's disease. We postulate that the clinical features of Parkinson's disease are more widespread than previously considered.

（Received : May 18, 2004）